Should you have surgery?
Filed under: Prevention, Drugs, Surgery
Should you have angioplasty? That decision lies between you and your doctor, but according to this article, drugs may work as well as the popular procedure at unblocking clogged arteries. In fact, angioplasty is one of five surgeries the author thinks most people should avoid. Others include hysterectomy, lower back surgery, and heartburn surgery. Instead, the author suggests non-surgical alternatives that may work as well or better than surgery.The angioplasty vs. drug debate is one that's been in the headlines for a while, and a quick Google search turns up enough conflicting findings to make a person's head spin. But before you go under the knife for any procedure, it's worth your time to investigate alternatives and make sure you're making the best choice for your health, whatever that decision may be.
[RESEARCH] Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial
Objectives To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up.
Design Randomised controlled trial.
Setting Nine Dutch hospitals.
Participants 283 patients with 6-12 weeks of sciatica.
Interventions Early surgery or an intended six months of continued conservative treatment, with delayed surgery if needed.
Main outcome measures Scores from Roland disability questionnaire for sciatica, visual analogue scale for leg pain, and Likert self rating scale of global perceived recovery.
Results Of the 141 patients assigned to undergo early surgery, 125 (89%) underwent microdiscectomy. Of the 142 patients assigned to conservative treatment, 62 (44%) eventually required surgery, seven doing so in the second year of follow-up. There was no significant overall difference between treatment arms in disability scores during the first two years (P=0.25). Improvement in leg pain was faster for patients randomised to early surgery, with a significant difference between "areas under the curves" over two years (P=0.05). This short term benefit of early surgery was no longer significant by six months and continued to narrow between six months and 24 months. Patient satisfaction decreased slightly between one and two years for both groups. At two years 20% of all patients reported an unsatisfactory outcome.
Conclusions Early surgery achieved more rapid relief of sciatica than conservative care, but outcomes were similar by one year and these did not change during the second year.
Trial Registry ISRCT No 26872154.
Combo surgery may put you at risk
Filed under: Research, Surgery
Published in yesterday's issue of Neurology, the journal of the American Academy of Neurology (typically, this can be found on the shelf next to Maxim and FHM in Border's), researchers have found that combining heart bypass surgery and carotid endarterectomy may increase the chance of death or postoperative stroke.
The study of discharge data from over 650,000 patients who had been admitted into hospitals in the U.S. for coronary bypass artery surgery or carotid endarterectomy from 1993 to 2002. It was discovered that patients who underwent both of these procedures at the same time had a 38 percent greater chance of stroke or death after the operation than did patients who had the coronary artery bypass surgery alone.
Doctors involved in this study now question whether if there is any benefit to performing these two procedures during the same hospitalization. They hope to arrive at an answer with a greater degree of certainty after holding further clinical trials.
[RESEARCH] Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial
Objective To determine whether recurrence of leg ulcers may be prevented by surgical correction of superficial venous reflux in addition to compression.
Design Randomised controlled trial.
Setting Specialist nurse led leg ulcer clinics in three UK vascular centres.
Participants 500 patients (500 legs) with open or recently healed leg ulcers and superficial venous reflux.
Interventions Compression alone or compression plus saphenous surgery.
Main outcome measures Primary outcomes were ulcer healing and ulcer recurrence. The secondary outcome was ulcer free time.
Results Ulcer healing rates at three years were 89% for the compression group and 93% for the compression plus surgery group (P=0.73, log rank test). Rates of ulcer recurrence at four years were 56% for the compression group and 31% for the compression plus surgery group (P<0.01). For patients with isolated superficial reflux, recurrence rates at four years were 51% for the compression group and 27% for the compress plus surgery group (P<0.01). For patients who had superficial with segmental deep reflux, recurrence rates at three years were 52% for the compression group and 24% for the compression plus surgery group (P=0.04). For patients with superficial and total deep reflux, recurrence rates at three years were 46% for the compression group and 32% for the compression plus surgery group (P=0.33). Patients in the compression plus surgery group experienced a greater proportion of ulcer free time after three years compared with patients in the compression group (78% v 71%; P=0.007, Mann-Whitney U test).
Conclusion Surgical correction of superficial venous reflux in addition to compression bandaging does not improve ulcer healing but reduces the recurrence of ulcers at four years and results in a greater proportion of ulcer free time.
Trial registration Current Controlled Trials ISRCTN07549334.
High percentage of children having surgery are overweight or obese
Filed under: Diet, Research, Obesity, Nutrition
Researchers from the University of Michigan Health System just released a report in the new issue of the National Medical Association, stating that a very high proportion of children having surgery are overweight or obese.
Examining a database of over 6,000 pediatric surgeries at the University of Michigan Hospital from 2000 to 2004, the researchers found that almost 32 percent of the patients were overweight or obese (with more than half of that 32 percent being obese). One of the major concerns, aside from the clear relationship to a nationwide rise in overweight and obese children, is that these children -- just like overweight and obese adults who undergo surgery -- are more likely to develop infections in their wounds.
The research also suggests that overweight and obese children have a greater likelihood of requiring particular types of surgery. Most frequently, overweight or obese children had to have their tonsils and adenoids removed. Additionally, overweight and obese children were more apt to require surgeries related to breathing problems and sleep apnea; orthopedic surgeries to mend broken bones; and procedures for dealing with gastrointestinal problems.
As stated, the marked increase in the number of overweight and obese children is not limited to Michigan alone, but applies to the entire nation. Over the past two decades, overweight and obesity in children has nearly tripled, just as it has concurrently risen in adults. This surgery related discovery is one of many associated health problems.
[RESEARCH] Comparison of hospital episode statistics and central cardiac audit database in public reporting of congenital heart surgery mortality
Objective To verify or refute the value of hospital episode statistics (HES) in determining 30 day mortality after open congenital cardiac surgery in infants nationally in comparison with central cardiac audit database (CCAD) information.
Design External review of paediatric cardiac surgical outcomes in England (HES) and all UK units (CCAD), as derived from each database.
Setting Congenital heart surgery centres in the United Kingdom.
Data sources HES for congenital heart surgery and corresponding information from CCAD for the period 1 April 2000 to 31 March 2002. HES was restricted to the 11 English centres; CCAD covered all 13 UK centres.
Main outcome measure Mortality within 30 days of open heart surgery in infants aged under 12 months.
Results In a direct comparison for the years when data from the 11 English centres were available from both databases, HES omitted between 5% and 38% of infants operated on in each centre. A median 40% (range 0-73%) shortfall occurred in identification of deaths by HES. As a result, mean 30 day mortality was underestimated at 4% by HES as compared with 8% for CCAD. In CCAD, between 1% and 23% of outcomes were missing in nine of 11 English centres used in the comparison (predominantly those for overseas patients). Accordingly, CCAD mortality could also be underestimated. Oxford provided the most complete dataset to HES, including all deaths recorded by CCAD. From three years of CCAD, Oxford's infant mortality from open cardiac surgery (10%) was not statistically different from the mean for all 13 UK centres (8%), in marked contrast to the conclusions drawn from HES for two of those years.
Conclusions Hospital episode statistics are unsatisfactory for the assessment of activity and outcomes in congenital heart surgery. The central cardiac audit database is more accurate and complete, but further work is needed to achieve fully comprehensive risk stratified mortality data. Given unresolved limitations in data quality, commercial organisations should reconsider placing centre specific or surgeon specific mortality data in the public domain.
[RESEARCH] Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation: cost utility analysis alongside a randomised controlled trial
Objective To determine whether the faster recovery after early surgery for sciatica compared with prolonged conservative care is attained at reasonable costs.
Design Cost utility analysis alongside a randomised controlled trial.
Setting Nine Dutch hospitals.
Participants 283 patients with sciatica for 6-12 weeks, caused by lumbar disc herniation.
Interventions Six months of prolonged conservative care compared with early surgery.
Main outcome measures Quality adjusted life years (QALYs) at one year and societal costs, estimated from patient reported utilities (UK and US EuroQol, SF-6D, and visual analogue scale) and diaries on costs (healthcare, patient’s costs, and productivity).
Results Compared with prolonged conservative care, early surgery provided faster recovery, with a gain in QALYs according to the UK EuroQol of 0.044 (95% confidence interval 0.005 to 0.083), the US EuroQol of 0.032 (0.005 to 0.059), the SF-6D of 0.024 (0.003 to 0.046), and the visual analogue scale of 0.032 (–0.003 to 0.066). From the healthcare perspective, early surgery resulted in higher costs (difference 1819 (£1449; $2832), 95% confidence interval 842 to 2790), with a cost utility ratio per QALY of 41 000 (14 000 to 430 000). From the societal perspective, savings on productivity costs led to a negligible total difference in cost (–12, –4029 to 4006).
Conclusions Faster recovery from sciatica makes early surgery likely to be cost effective compared with prolonged conservative care. The estimated difference in healthcare costs was acceptable and was compensated for by the difference in absenteeism from work. For a willingness to pay of 40 000 or more per QALY, early surgery need not be withheld for economic reasons.
Trial registration Current Controlled Trials ISRCTN 26872154.
Robotic Arms help make heart sugery safer
Filed under: Surgery
Sometimes I cluck in dismay when I'm at the supermarket and see the self-serve check-outs. I mean, they're convenient and all but it sometimes seem like we're destined to become the robot society that was made light of in the 60s. How long until everything is run by computers?But when it comes to surgery--where the steadiness of a surgeons hand is a matter of life and death--the use of robotic arms to treat patients with atrial fibrillation (abnormal heartbeat) shows promise. So far, 20 operations have been performed on patients in Britain, and each has been highly successful. So while the momentum that technology is gaining can sometimes be frightening, it's also really exciting what the future can hold for us.
Post-op diabetes risk factors
Filed under: Research
In the January 2007 issue of the the journal Liver Transplantation, the official journal of the American Association for the Study of Liver Disease (AASLD), French scientists published an article suggesting a link between certain risk factors and new-onset diabetes mellitus (NODM) following liver transplantation.
Specifically, a history of impaired fasting glucose, obesity and hepatitis C infection -- when paired with the use of an of immunosppressant -- was shown to be associated with an increased risk of NODM.
The study, conducted by a team of researchers at the Hospital Paul Brousse in Villejuif, France, included 211 patients from 10 transplant centers who had undergone a liver transplant between October of 2003 and June of 2004. The patients' records were reviewed and their fasting blood sugar levels were recorded 3, 6, 12, and 18 months after the surgery. Those patients with NODM had their date of diagnosis noted, in addition to the immunosuppressive treatment and diabetes management they received.
The results demonstrated an incident of NODM of 22.7 percent, with most cases being diagnosed within three months after transplant surgery. Moreover, 12.4 percent of the patients with normal glucose levels before the surgery developed impaired fasting glucose.
10 things you need to know about your heart problems
Filed under: Drugs, Women Heart Health, Men Heart Health, Aging Heart Health, Surgery
You've been diagnosed with a heart problem. You have a lot of questions but you can't seem to get your head around this, this thing that's just been dropped on you like bomb. You probably feel very alone but believe it or not, situations like this are pretty common so WebMD has come up with this handy list of things you should ask your doctor about your heart condition. You need to know the facts, what can be done and where you'll end up on this roller coaster of life--and you might not know which questions to ask. Either that or you're too overwhelmed to think it through. You can even print the list out and take it to your doctor.
If you've gone through this before, what information did you find the most useful?